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FROM THE DOC
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Our Legacy
The opiate epidemic is a multifaceted problem that has a huge impact on the country and families. It is important to understand what the problem consists of so that we can take appropriate measures to resolve it, and as patients, it's important to understand your connection to the issue.
The book,
Dreamland: The true Tale of America's Opiate Epidemic by Sam Quinones, provides a superb summary of the problem but let me give you the sketch that he describes so that you can have an understanding of the problem.
This epidemic is fueled by four sources, of descending importance:
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Black Tar Heroin.
Most important: This inexpensive Mexican heroin is readily available on the streets of every large and medium-sized city in America. Unlike the powdered heroin of the 70's-90's, the type we all think of ....like in the move The French Connection. This is a tarry substance that costs pennies on-the-dollar compared to the powdered heroin of yesteryear, and with the use of cell phones and computers, is readily available for delivery to your door 24/7.
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Synthetic narcotic compounds like Fentanyl.
These super-strong opiates are produced in illegal labs in Asia and are used knowingly by high level narcotic addicts who require the stronger medication or are mixed into the black-tar heroin to create a stronger high. They are of such potency that they can cause an overdose in very tiny amounts in anyone who does not have tolerance to such medication
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Pill Mills
These are the doctors and pharmacies, primarily in the Midwest but also in other parts of the country, that provide handfuls of prescription narcotics for diversion to the local population. These are the Ohio pharmacies receiving millions of pills per year in narcotics like Percocet, Hydrocodone, and Oxycontin that are then ending up in the hands of addicts in the local communities. These pills are fueling an illicit economy in the rust-belt, provided much needed income for people who have been caught in economic hardship, or those just trying to make a buck.
- Diversion of everyday pain pill prescriptions.
These are the pills stolen from our homes, and include high dose Oxycontin, or patients who are 'drug seeking' and obtaining pills due to their own addiction issues that are either untreated or unrecognized.
Each of the above sources of the problem will require a different approach to curb this epidemic. We can all do our part by using our own narcotic medications appropriately and effectively when needed, and by storing them safely, to prevent them from coming into hands of those who could harm themselves or others.
We do not need to forgo pain medication because of this epidemic, but we each need to be more thoughtful and careful in our use of such medications.
- Dr. Lakin
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| VOL 14 / Issue: #2 |
Spring/ 2018 |
To Prevent Alzheimer's, Stay Reasonably Fit. . . . . .
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Women who were reasonably fit when they were middle-aged were much less likely to develop dementia than women who struggled to exercise even a little bit, researchers reported Wednesday.
The fittest women were 90 percent less likely to later develop dementia than those who were the least fit, the team at Gothenburg University in Sweden found.
In this case, being highly fit meant everyday exercisers, not athletes.
The study suggests not only that exercise can prevent dementia, but probably also shows that people destined to develop dementia are already showing some physical symptoms decades earlier.
And they were not talking about super-fitness, but a very average ability to ride a bike for a few minutes, said Laura Baker of the Wake Forest School of Medicine in North Carolina, who is conducting her own studies into fitness and dementia.
One study found that patients who walked at a moderately brisk pace for an hour, three times a week, not only did better on memory and attention tests, but they lost weight and lowered their blood pressure.
To Read more.... Click
HERE!
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Dr. Lakin Named "Top Doc" Again For 2018!
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 Every year the Phoenix Magazine publishes a guide featuring over 500 of the Valley's best physicians. The doctors are selected through a peer-review survey. The theory is that medical professionals are the best qualified to judge medical professionals.
The survey asks the doctors to nominate those doctors who, in their judgment, are the best in their fields. Once again, Dr. Lakin has been chosen as a TOP DOC among his peers.
Please join us in congratulating Dr. Lakin again for the 17th year!
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What's Happening When Limbs Fall Asleep?
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The unpleasant sensation of "pins and needles" that occurs when a hand or foot falls asleep is a feeling that most people would probably like to avoid. While a limb is asleep, there is typically no sensation at all, but the moment you change positions, you're struck with this uncomfortable tingling sensation, which may even be painful. There is a widespread misconception that pins and needles is caused by a surge of blood flowing back into the limb, but that is rarely the case. The culprit behind sleeping limbs and their unpleasant awakening is more likely your nervous system, not your veins and arteries. So let's take a closer look at what exactly happens when your limbs fall asleep and how you might avoid this irritating problem.
Understand your nervous system
Your peripheral nervous system allows all parts of your body to communicate with the brain and spinal cord, which comprise the central nervous system. When a nerve is compressed, its communication with the brain is cut off along with the fresh supply of oxygenated blood to the nerve. For some nerves, there will be no sensation until you move and restore the lines of communication and blood flow, though others might fire off erratic impulses causing a light tingling or numbness. This sensation goes by the scientific name paresthesia, though we tend to refer to it casually as pins and needles.
Keep your body moving
Common sources of nerve compression that can cause nerves to fall asleep are sitting with legs crossed and falling asleep on your arm. Therefore, you can typically avoid letting your limbs fall asleep by maintaining good posture and moving around frequently-particularly if you spend most of your day sitting at a desk. In some cases, nerve compression is not relieved by movement, meaning that numbness and tingling may be persistent sensations. Conditions such as carpal tunnel syndrome or herniated spinal discs are linked with these symptoms, and they may require specialized orthopedic care for relief.
- By Body Odd
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New Medicare ID Cards in 2018
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Medicare currently uses a Social Security based ID number to identify people with Medicare and administer the program. On April 1, 2018 Medicare will begin the process of discontinuing Social Security numbers for identification and will begin sending new Medicare cards to Medicare recipients with new ID numbers.
Your new Medicare ID number will replace the Social Security number that is currently on all Medicare ID cards. Your new Medicare number will be specific to you and should be protected as personally identifiable information but must be provided to your medical doctors so your medical claims can be billed. The ID number on your new Medicare card will be different than your current ID number, randomly generated, and have uppercase letters that are "non-intelligent," which means they don't have any hidden or special meaning.
Moving to new Medicare numbers and issuing new Medicare cards requires a lot of change to the current system and it is a change that will be nationwide and gradual beginning no earlier than April 1, 2018 and running through December 31, 2019. This means your new Medicare card can arrive anytime within this time frame. Release of the new ID cards will be timed and controlled by Medicare. Your old Medicare cards should not be discarded but can be filed safely away.
Your new Medicare card will not change your Medicare benefits and patients with Medicare should start giving the new Medicare cards to their health care providers as soon as they arrive. It is important to know the transition period for Medicare providers also begins on April 1, 2018 and will run through December 31, 2019. This means Medicare providers have until January 1, 2020 to begin exclusively billing with the new Medicare ID numbers. Some Medicare providers will begin using the new ID numbers as soon as April 1, 2018, others will be closer to the December 31, 2019 deadline. This decision is made on a case by case basis and is perfectly acceptable under the terms of the Medicare program. A provider may require you provide your "old" Medicare card in order to submit your claim, as long services were provided prior to the December 31, 2019 deadline this is also acceptable.
If you have questions, please contact Veronica, our Billing Supervisor.
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Introducing Genetic Testing By Myriad, Available In Our Office Now. . . . .
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The Myriad Hereditary Cancer test is a 28-gene panel that identifies an elevated risk for eight hereditary cancers:
Genetic screening is now a practical tool that we can use to help in the management of your health and the health of your family. It is recommended by the USPTF (United States Preventive Services Task Force.) This has implications for you, but also for your family, and I think it is worthwhile to consider.
We are at the beginning stages of applying this science in the clinical setting, so it is of limited scope of application. I want to help determine if it can be applied to your particular family history. This questionnaire is meant to do just that.
- Determine if you are at risk for cancers that run in the family
- Determine if genetic testing, at it's current state of development, is applicable to your situation
- Have the testing done to determine the best monitoring strategy, as well as helping guide you and your family in future testing and monitoring.
You will notice that this questionnaire has a specific focus on certain cancers, as that is the state of practical application of current genetic testing.
We are using a 24-gene panel from Myriad labs, the inventors of the BRCA test, which was the first large-scale genetic test validated for breast cancer family history.
For now, only a select group of patients can benefit. In the future, genetic testing will become commonplace and perhaps done routinely for everyone.
Answer the following questions and we will determine if you can benefit from this testing right now.
As for the cost, insurance coverage, and privacy issues related to such testing, this will be answered prior to running the test, so feel free to provide this information to initially see if you can benefit.
The process:
Complete this questionnaire
Submit a specimen of saliva (spit test).....this will be the material that is genetically tested.
Myriad labs will contact you to review cost, insurance, and privacy issues before any testing is performed.
Once completed, you will receive a detailed report and we can review it together to determine the best strategy for monitoring your health on an ongoing basis, as well as having specific advice for monitoring of your family members.
In the future, should additional testing become available that is valid to do, your current information will be used in such an analysis.
** Click HERE for more information and to take the Myriad Genetic test
to see if you are at risk.
If you think you are at risk and would like more information, please contact our office to schedule an appointment with Dr Lakin.
'Knowledge is Power!'
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Why Do We Have Eyebrows and Eyelashes?
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 If you take a long look in the mirror and really focus on your eyebrows and eyelashes, these fuzzy features may begin to look strange. Why do we have hair above and around our eyes? Are eyebrows and eyelashes important to our health or are they just aesthetic features that help us look a certain way or express an emotion? As humans evolved, we lost a lot of excess body and facial hair along the way. But the eyebrows and eyelashes remained a core part of our features. We still have eyebrows and lashes because these assets help to keep our eyes clean and vision clear. Let's take a closer look at why we need eyebrows and eyelashes below:
Eyebrows Move Moisture Away from the Eyes
Clear vision is important to human survival and eyebrows help preserve vision by protecting against moisture and sweat. The arched shape of eyebrows actually redirects moisture over to the sides of our face, away from the eyes. Many experts believe that if humans did not evolve to have eyebrows, we may have developed extremely pronounced foreheads or really long eyelashes to help keep moisture out.
Eyelashes Prevent Irritation and Infection
Your eyelashes are meant to serve as a protective barrier to seal off your eyes from foreign objects or moisture and prevent irritation or infection. When you close your eyes, the curled lashes connect to form a seal and keep unwanted particles out. If your eyes are open, the curved shape of your lashes will help move water away from the eye. Eyelashes also help us to detect foreign objects that get too close. For example, if a gnat is buzzing by your eyes and your lashes sense that movement they will trigger your eye to blink for protection. Now that you realize the importance of these furry facial features, keep your eyebrows and eyelashes healthy.
- By Body Odd
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8 Ways To Spring Clean Your Health Routine. . . . . .
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But why stop with your personal space? Your physical well being may need some sprucing up, too!
PUT YOURSELF ON YOUR TO-DO LIST
Spring is the perfect time to re-evaluate your habits. When you're always putting other people's needs ahead of your own, your performance as a parent, professional and leader can suffer.
JUST GET OUTSIDE
Sure, there are plenty of outdoor activities to enjoy when the weather gets warmer, but simply getting out of the house, office, apartment or wherever you've been hibernating can be beneficial, too. The outdoor setting can
help relieve stress and can also provide an opportunity to be present and enjoy people you love - both ways to round out your self-care routine.
M
ost of us are in a vitamin D deficit, and it's smart to get a small amount of unprotected sun exposure - say 10 minutes a day - in order to let your body produce the vitamin (apply sunscreen after that). Vitamin D is linked to helping prevent everything from osteoporosis, to
heart disease and certain types of cancer. And no one can argue the fact that sunshine just makes you feel awesome."
Take your fitness to the next level by adding in tabata interval workouts at the end of your routine. These
four-minute bursts of high-intensity training can maximize your workout and your results, according to Nashville-based celebrity fitness trainer, Josh Rogers, who recommends alternating between 20 seconds of max training followed by a 10-second rest for a total of eight rounds. "These workouts are fast-paced and fun, and
burn up tons of calories," he says. His sample routine: Use a burpee and plank jack as your tabata exercises. Perform 20 seconds of burpees followed by a 10 second rest, then 20 seconds of plank jacks followed by another 10 second rest, and repeat for four minutes (a total of eight rounds).
GIVE GARDENING A GO
Spring is the time to get your seeds planted and start growing some produce. Growing your own garden pays off in a number of ways. "Studies show that people who home garden
are happier and eat more healthfully," says Palmer. She recommends starting with a tomato plant, basil, parsley, greens, carrots, zucchini or radishes, which are some of the easier veggies to grow. Kate Scarlata, RDN also recommends spring veggies, whether you garden or not. Eating a variety of seasonal produce, such as baby salad greens, carrots, fennel, asparagus and green beans, provides a
wide range of fibers. Scarlata explains that certain fibers feed the good gut microbes, while others keep things moving along your digestive tract. "A variety of veggies in the diet is shown to
bolster gut health," she says.
Nutritionist Cynthia Sass, MPH, RD author of Slim Down Now: Shed Pounds and Inches With Pulses - The New Superfood, recommends giving your spice rack a thorough cleaning. "Dried herbs and spices add flavor, aroma and antioxidants to meals, and allow you to season foods without using excess salt and
sugar. They've also been shown to boost satiety and
rev up
metabolism. But, they lose potency as they age," she explains. Sass suggests taking inventory a few times of year and replacing your older spices with fresh stock. When you buy new spices this spring, she also suggests buying smaller quantities. "That way, you'll go through them faster and it won't lead to waste."
UNPLUG
The recommended seven to nine hours of sleep are an extremely important time for your brain and body. In fact,
cutting your snooze short by just one hour can directly affect your health. Everything from your mood to your immune system to your risk of weight gain can get thrown off kilter if you aren't getting enough sleep. But
getting proper rest isn't as simple as getting in bed at a certain time. When that timer goes off tonight, put your phone on airplane mode. No more emails. Turn off your TV and computer. Dim your lights. Get ready for bed and the day ahead of you."
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by Samantha Cassetty, RD, Better Living, NBC Health
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Here's Why Cockroaches
Are Indestructible!
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Genome sequencing reveals the secrets of this nasty insect!
They can regrow lost legs. They make their own antibiotics. And they have an almost supernatural sense of smell.
Now Chinese researchers have sequenced the genome of the American cockroach and discovered why they are so hard to kill.
It's all in the DNA!
The American cockroach, known scientifically as Periplanta Americana, has an enormous genome, Shuai Zhan and colleagues at the Chinese Academy of Sciences in Shanghai, found.
And it's more closely related to termites than it is to German cockroaches, despite their shared unsanitary habits and ability to horrify homeowners and terrorize tenants.
Cockroaches spread germs and can aggravate asthma and allergies.
"The harm of American cockroaches is becoming more serious with the threat of global warming," Zhan's team wrote. "Our study may shed light on both controlling and making use of this insect."
And the DNA explains why they are so prolific.
When under stress, females can lay unfertilized eggs that will hatch in a process called parthenogenesis or "virgin" reproduction. The team found genes that explain how this can happen.
Cockroaches can regenerate limbs
They can also survive terrible injuries.
"The American cockroach has a strong capability of limb regeneration during the nymph stages, which is the main reason to call it 'Xiao Qiang' in China," the researchers wrote. The name translates as "little mighty one," and the team found genetic pathways that underlie the process.
DNA can also explain their noxious habits.
"Cockroaches generally live in moist and unsanitary areas and are particularly fond of fermenting foods; thus, they have numerous opportunities to be exposed to microbes and pathogens," the team wrote. The insects have extra genes related to chemoreception, or smell.
And the insects have evolved sophisticated ways to deal with their dirty environments. Their cells respond to infection with bacteria and fungi by secreting antimicrobial peptides that go into the hemolymph - the juice that squirts out when you stomp on a roach.
Plus they have natural detoxification mechanisms. Targeting these genetic pathways might be a better way to kill the pests, the Shanghai researchers suggested.
It also might be possible to exploit these properties, they said.
"Beyond serving as a pest, this cockroach is also important in traditional Chinese medicine, well documented in Chinese medical encyclopedias," they wrote. "Moreover, its ethanol extract has been developed as a prescribed drug (Kang Fu Xin Ye) for wound healing and tissue repair."
Understanding the genetic secrets could help scientists replicate the cockroach's superpowers, they said.
Disgusting!
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by Maggie Fox, NBC, Health
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DR. LAKIN'S NEW SECURE PATIENT PORTAL
'MyHealthRecord.com'
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Dr. Lakin and staff are very excited to announce we have upgraded our secure patient portal!
We changed vendors, and our new secure portal,
MyHealthRecord.com, is easier to use and easier for us to respond to your requests.
At your convenience
- View your health record from any Internet-enabled device
- Exchange secure messages with Dr. Lakin or our staff
- Request and manage appointments
Anytime access
- Lab orders
- Test results
- Upcoming appointments
- New Document and articles from Dr Lakin
To access our new patient portal, MyHealthRecord.com, you are required to complete a short questionnaire. This is a very simple process.... quick and easy. If you need assistance, we are always here to help.
Call us for your invitation email!
It will give you all the information you need to use our secure portal, MyHealthRecord.com, for your medical care!
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Dental Tips From Marie
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 Is Tooth Whitening for You?
The importance of daily brushing and flossing practices to maintain good oral health cannot be overstated. However, if you feel your smile is not as bright or has become more yellow, there may be a solution which may add a bit of sparkle to your smile.
One treatment to consider is tooth whitening, which can lighten or help to remove stains and discoloration. It is not the answer for everyone nor is it a permanent, one-time procedure.
Tooth Color and What May Affect It
The surface of the crowns of teeth is covered with enamel; its color is affected by the color of the dentin layer under it. Your genes affect the thickness and smoothness of the enamel. Thinner enamel allows more of the color of the dentin to show through. Having smoother or rougher enamel also affects the reflection of light and, therefore, the color. In addition, every day a thin coating (pellicle) forms on the enamel and will pick up stains and tooth enamel contains pores that can hold stains and cause discoloration.
Why Teeth Can Change Color
Over time, teeth can change color for a number of reasons, some of the most common are the following:
Foods and Beverages
which have intense color pigments called chromogens that attach to the enamel are some of the major staining culprits, such as coffee, tea, red wine, some sports drinks, and berries.
Tobacco Use
can create stubborn stains from the tar and nicotine chemicals found in tobacco. Tar is naturally dark and nicotine, colorless until mixed with oxygen, turns into a yellowish, surface-staining substance.
Trauma
from an injury to the mouth may cause a tooth to change color because it reacts to an injury by laying down dentin, which is a darker layer under the enamel. Or, if there is bleeding into the dentinal tubules, the tooth will appear darker.
Medications
such as antihistamines, antipsychotics, and some treating high blood pressure can have a tooth-darkening side-effect.
It is possible to have stains inside the tooth; these are called intrinsic stains. They can be caused by exposure to excessive fluoride as a child, while teeth are developing. Also, children exposed to antibiotics like tetracycline and doxycycline when their teeth were forming (either
in the womb or infancy or early childhood) may have discoloration of their adult teeth later in life. Chemotherapy and head and neck radiation therapy can also darken teeth.
Tooth whitening is most effective on the surface of extrinsic stains.
Areas for Successful Whitening - or Not - and Necessary Preparation
It is obviously important to have a conversation with your dentist before deciding to whiten your teeth to determine if you are a candidate for whitening, since whiteners may not correct all types of discoloration.
If gum tissue has receded, the exposed root areas may appear yellow or discolored. Whitening products will not make them whiter. Also, whitening will not be effective on caps, veneers, crowns, or fillings, nor intrinsic discoloration (described above) or resulting from medications or traumatic tooth injury. Yellow teeth typically lighten well, brown teeth may not respond as well, and teeth with gray tones may not bleach at all.
Regarding preparation for whitening, teeth with cavities need to be treated and restored before teeth are whitened. Whitening solution can possibly pass through decayed areas and reach the inner parts of a tooth which could create a problem.
Finally, the dentist or dental hygienist will clean your teeth to thoroughly remove the bacteria, food and other substances that may build up on your teeth and contribute to the staining. Following this the whitening procedure can begin.
Whitening can be done in the dental office or at home. For in-office whitening, the dentist will usually take a photograph of your teeth to assist in monitoring the progress of the treatment.
How it is Done - In-Office or At Home
There are two main types of procedures. Vital whitening is done on teeth that have vital/live nerves. Non-vital whitening is done on a tooth that has had root-canal treatment and no longer has a vital nerve.
The whitening products contain bleaching agents, some form of hydrogen peroxide or carbamide peroxide. In-office whitening allows your dentist to use a more powerful whitening product. A specialized light or laser that activates the whitening gel and allows the bleaching process to occur faster may be used.
The typical in-office vital tooth whitening uses a gel that is applied directly to the tooth surface after a rubber shield is used to protect the gum tissue or a protective gel is applied to the gum tissue. It is at this point that activating laser/lights may be used. The procedure can take 30 to 90 minutes and you may require one to three appointments. The time and number of
appointments will depend on the method used, how severe the stains are, or how light you want your teeth. Different types of stains will have various responses to the treatment.
For badly discolored teeth, it may be suggested that the process be continued at home for a recommended period. For at-home whitening, your dentist will take impressions of your upper and lower teeth for custom mouthpieces (trays) to be made. The mouthpiece needs to fit well so that the whitening agent remains in contact with the teeth. At home, the mouthpiece is filled with the gel provided by the dentist and worn for a prescribed time over days or weeks - however long it takes to achieve the desired results. With this approach you have the convenience of the treatment at home, with the supervision of your dentist; however, it may take a little longer.
Whitening products can be purchased over-the-counter. They contain a weaker or lower concentration of whitening agent than that used in the dental office; therefore, the process may take much longer. The whitening agent is applied in a standard mouthpiece or as a strip that sticks to your teeth. Should you decide to use an over-the-counter product, discuss this option with your dentist and look for the one with the ADA Seal of Acceptance which means it has been tested to be safe and effective for teeth whitening.
For non-vital whitening, because of the potential for intrinsic staining, a process will be used that whitens the tooth from the inside. A whitening agent will be place inside the tooth with a temporary filling over it. The tooth may be left this way for several days and repeated, if needed, until the tooth reaches the desired resulting shade.
Are There Risks?
Serious side effects from whitening are unlikely. However, some people report an increased sensitivity for a brief time or a temporary, mild gum irritation. Since the effect of the whitening materials on the development of a fetus are not known, it is recommended that women should not have their teeth whitened while pregnant and the cosmetic procedure postponed until after delivery.
Follow-Up
Whitening is not a permanent solution. The stains will return. If you are a smoker or frequently consume staining foods or beverages, the whiteness may start to fade in as little as one month. However, if these sources of straining are avoided, another whitening treatment may not be needed for six to twelve months. Using a straw is recommended when drinking beverages to keep stain-causing dyes away from your teeth. Eliminating tobacco can help to keep your teeth bright.
Re-whitening can be done in the dentist's office or at home. Be sure to discuss your whitening schedule and which whitening products would work best for you with your dentist.
If you feel you would benefit from whitening you teeth, contact your dentist for a consultation. Most importantly, enjoy a comfortable, happy smile.
Here's to your good health!
Marie C. Jacobs, D.D.S.
Professor Emerita Loyola University Chicago
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Are You Having an Earwax Problem?
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Most people keep cotton swabs in the bathroom to clean out their ears, and some will even go as far as ear candling to use heat to melt earwax away, but are these steps necessary or even beneficial to your health?
Often, we think of earwax as a dirty substance, though it only exists to keep the ears clean. Earwax traps dust, dirt, and other types of debris before these substances can make their way into the inner ear, which could sustain serious damage from small particles.
Still, it can create an unpleasant sensation in your ears, especially if you suffer from excessive earwax buildup. Before you reach for a Q-tip or light up an ear candle, however, you should talk to your doctor about how to properly clean out your ears.
Are you cleaning your ears correctly?
For most people, a wet cloth will be sufficient for removing wax on the outer part of the ear. Using a cotton swab or similar tool may seem effective, but it can actually push earwax back into the ear, causing more to build up. In addition, cotton swabs pose a risk for slipping into the ear canal and damaging the eardrum - an injury that will cause a lot more discomfort than a little excess earwax. Ear candling is even more dangerous, because it involves placing a lit candle in close proximity of your ear. Though advocates of ear candling say that it effectively removes wax and any toxins accumulated in the ear, it is at best an ineffective cleaning solution and at worst a quick way to set your hair on fire. Some at-home solutions like ear drops may be safe and effective, but they should still only be used following a doctor's recommendation.
Do you have a healthy amount of earwax?
If wiping your ears with a washcloth does not provide the clean feel you're after, you might have excessive earwax buildup. This is a relatively common condition, which may be caused by overcleaning itself. Symptoms such as itching, pain in the ear, ringing in the ears, or partial hearing loss can all be attributed to excessive earwax buildup, but there may be other problems present as well. This is all the more reason to talk to your primary physician or an ENT specialist so that you can properly care for your ears.
Excess earwax may not seem like the most pressing of health concerns, but it is still something to speak to a physician about.
To watch an actual ear wax removal
CLICK HERE!
- By Body Odd
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Which Girl Scout Cookie is the Healthiest?
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We're in the thick of
Girl Scout cookie season and the boxes are rolling in. Are you looking at the nutrition labels and having buyer's remorse?
Well, don't panic. Girl Scout cookies are treats; they're not meant to be healthy staples in your diet.
Girl Scout cookies do have a few things going for them. First of all, by buying them, you're supporting girls (and getting some serious brownie points). Secondly, Girl Scout cookies are not following the super-size portion trend.
Below is our breakdown of 2018 Girl Scout cookies from better to worst. We've sized up the nutrition labels* with a strong focus on calories, fat and sugar content per serving.
1. Shortbread aka Trefoils®
Coming in first place, these simple shortbread-style cookies contain only 4 grams of sugar per serving (and a serving is 4 to 5 cookies, depending on which licensed baker baked the cookies). They're also
pretty low in calories compared to most of the other cookies. No wonder they're a top-five best-seller!
These chocolate chip, peanut butter, oatmeal cookies contain nutrition-positive ingredients like whole-grain oats and peanut butter, so they're rolling in at No. 2. They're also gluten-free, which makes them a good choice for anyone following a gluten-free diet.
3. Do-si-dos® aka Peanut Butter Sandwich
These best-selling cookies also contain both oats and peanut butter. The Peanut Butter Sandwich features peanut butter as its first ingredient, contains an extra gram of dietary fiber, and has only 6 grams of sugar compared to the Do-si-dos®, which contain 11 grams of sugar per serving.
4. Toffee-tastic™
The buttery Toffee-tastic™ cookies are made with rice flour instead of wheat flour, so this is another gluten-free choice that's fairly low in calories and sugar.
5. Peanut Butter Patties® aka Tagalongs®
While these vegan-friendly top-sellers do contain peanut butter, they don't contain any whole grains, so we've bumped them down. The sugar and calorie counts aren't too bad, but the Tagalongs® contain partially hydrogenated oil, which can increase your risk of heart disease and may even increase your risk for type 2 diabetes, says Cassetty.
6. Savannah Smiles®
While these zesty lemon wedges do contain a little lemon juice, they also contain four different types of sugar, which isn't really anything to smile about. Their calorie count and sugar content lands them in the middle of the list.
7. Lemonades™
The name for these tangy vegan-friendly cookies is a little misleading, considering that lemon juice does not appear on the ingredients list. They contain a little less sugar than the lemony Savannah Smiles®, but more calories from fat.
8. Thanks-A-Lot®
These vegan shortbread-style cookies are dipped in chocolate and embossed with the words for "thank you" in different languages. However, they're a little higher in calories and sugar than many of the other cookies, so you may want to say, "Thanks, but no thanks," to these.
9. Thin Mints®
According to
a survey by the neighborhood social networking site, Nextdoor, 38 percent of the 6,500 respondents pledged their loyalty to Team Thin Mint. Sadly, one of the Girl Scouts' most classic and best-selling cookies is also one of the highest in calories and sugar. The upside is that there are four vegan-friendly chocolate mint wafers in a serving, so if they're a favorite, you can limit yourself to just one. Or maybe two. (Not a whole sleeve!)
Devotees of the Caramel Delites® (aka Samoas®) may be disappointed - though probably not surprised - to learn that these best-selling caramel, chocolate and coconut cookies contain a lot of sugar, fat and calories. What's worse: Samoas® contain partially hydrogenated oils too.
11. Girl Scout S'mores™
There are two different versions of this newer Girl Scout cookie. The version made by Little Brownie Bakers is a graham cookie sandwich with marshmallow and chocolate filling. The one made by ABC Bakers is a single graham cookie coated in icing and dipped in chocolate. "They both have a lot of calories, fat and sugar," says McKittrick. And the ABC Bakers' version contains the most calories and sugar per serving of all the cookies that the Girl Scouts are selling this year.
* The Girls Scouts license two different bakers to make the cookies, so some of the ingredients and nutrition details vary. Be sure to check the labels on your cookie packages for accurate nutrition information.
- By
Jen Laskey , NBC Reporting
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We Love Your Pets. . . . .
But Please Keep Them Comfortable At Home!
**We do welcome Service Animals specifically trained to aid a person with a disability.
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Under the ADA and Arizona law, your service animal must meet these conditions:
- Not pose a direct threat to health and safety, can't be aggressive, bark or snap at other patients
- Be housebroken and positioned off all furniture
- Be in your control at all times
- Not pose an undue burden on the office or fundamentally alter the nature of the our healthcare practice
**Sorry, but 'Emotional support' or 'Hospitality' pets are not considered 'Service Animals' under ADA and Arizona law and should be left at home.
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Rx Prior Auth News From Jeff
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The ABC's of ePAs
Prior Authorizations (PAs) are a fact of life for a growing number of prescription drugs needing payment coverage by insurance plans. What was once a rather innocuous requirement for a small group of pricier brand or specialty drugs may now include common and generic medications; PAs can be triggered for seemingly the most inane reasons.
Cost is the usual suspect. Insurance plans, or their clearinghouse-appointed PBMs, judge your drug largely upon their cost of a medication. Over the years new hurdles have been imposed in having a drug approved for payment, i.e., formulary vs non-formulary, tier assignments and try/fail requirements.
Insurers claim it helps reign in prices. So they say. Many professional healthcare and consumer groups refute that assertion. Drug prices continue to surpass inflation thereby pulling money out of patients' pockets while putting it into the coffers of corporations and shareholders. And often-time arbitrary PA processes and lack of pricing transparency by the stakeholders has made it all the more damning.
Survey Says...
According to a 2017 study by the American Medical Association (AMA), 84% of physicians describe the burden associated with PAs for themselves and their staff as high or extremely high. In addition, 86% reported the PA burden has increased significantly over the past five years. Result: "Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment," according to AMA Chair-Elect Jack Resneck Jr, MD.
Can You Hear me now?
Phone and fax were the status quo for submitting a prior authorization. The latest wrinkle is an online electronic prior authorization or ePA. Many drug plans now require PAs submitted online. They tout ePAs as convenient, simple and fast. Convenient? Maybe less faxes/calls for insurers. As simple as ABC? Hardly. Does it save time? Not always. The question set can change at any time. You/we must still submit any
proof necessary for a decision. An ePA request may be accepted quicker but it can still slow to a halt if a Plan or PBM wants more questions answered, proof of try/fail, lab data, charts, etc.
What's in your Wallet?
The move to ePAs by your drug plan means, more than ever, we must have your current drug plan card on file in our office. We need to know the BIN, PCN, RxGrp and your member ID numbers shown on your drug plan card before we can start anything in your behalf. (See infographic)
The ABC's of ePA's
Help us start and expedite the process of having your medication approved by following these tips:
- Always update and carry your current drug plan card. Don't leave home without it.
- Beaware of annual formulary and tier changes in your drug plan. Read the fine print.
- Call your Plan's toll-free customer service phone for a status. It's automated as well.
The ePA Process
A computer is the 'authority' that decides to approve or deny your drug initially. Its software program "considers" your initial request based strictly on your plan's formulary, tiers and exclusions and then issues either a thumbs-up or down, impersonal.
Another round of review may be initiated if you or your doctor disagree with your Plan's earlier decision and can offer compelling labs/data or attest to "medical necessity" and thereby overturn the earlier decision. This review is more personal and is conducted by your drug plan's PBM technicians and/or pharmacists, aka "clinical team." Once again, they tend to adhere/decide mainly according to your Plan's current formulary and guidelines.
Your last shot may be via a formal "appeal" process. It requires more substantial paperwork, labs, statements, etc. It is much lengthier, from one to three months for a determination. In the end, there is no guarantee your medication will be allowed despite all efforts.
Like it or not, ePA's are the future of prior authorizations as we know them. Keep your Rx plan card and information updated and on file with our office. ePAs may not be as simple to master as your abc's but you/we don't stand a chance without the proper information and tools to handle them.
Jeff, Rx PA Specialist
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What Causes Eye Twitching?
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 Almost everyone has experienced the strange sensation of an
eyelid twitch, which can feel like a shutter or a shiver in the eye. Though odd, this sensation is not often indicative of a major health or vision problem if it is only felt occasionally. There are, however, some underlying causes of eye twitching that can compromise your health over time, so it's important to recognize what causes involuntary spasms in the eyelids and how to address these issues. If you feel your eye twitching often or for a prolonged period of time, you should see an ophthalmologist to explore the possibility of conditions like blepharospasm, dystonia, or hemifacial spasm. Because these conditions are very rare, it is more likely that annoying eye twitches are related to one or more of the following causes:
Too much caffeine
Caffeine may be a fixture in your daily routine in the form of coffee, tea, or energy drinks, but overconsuming caffeine can lead to a multitude of problems. Poor sleep is a common issue, along with jitteriness and eye spasms. Taking a break from caffeine can help to relieve eye twitching and improve your overall health by improving your nightly sleep.
Heavy eye strain
For many of us, screen time is an inevitability with so many careers relying on computer and smartphone use throughout the day. Constantly staring at these devices can lead to
eye strain, which might cause headaches, eye twitching, and fatigue. To combat eye strain when you cannot get away from your devices, follow the 20-20-20 rule: For every 20 minutes that you are looking at a computer, take a break for 20 seconds and focus on an object at least 20 feet away.
When
allergies cause eye irritation, there are many uncomfortable side effects that can occur. Watery, itchy eyes are common among allergy sufferers, who might have a habit of rubbing their eyes without a second thought. This, however, is a bad habit to sustain for itchy eye relief, since rubbing the eyes will only cause further irritation, which may manifest eye twitching.
Similar to allergy eyes, dry eyes can be a significant source of irritation in many forms. Older adults commonly experience dry eyes as a result of the aging process or use of certain medications.
Contact lens wearers may also experience frequently dry eyes, particularly while wearing hard contact lenses, which are less permeable and more likely to trap irritants against the cornea. Wearing your glasses more often or considering alternative vision correction treatments like LASIK might be a solution for twitching eyes if contacts are the cause. Otherwise, over-the-counter eye drops may provide some temporary relief, though prescription eye drops are often needed for chronic dry eye sufferers.
Because stress is such a detriment to your health, it likely comes as no surprise that stress can also be the culprit behind your eye twitching. If you find that eyelid spasms tend to occur in moments when you feel particularly stressed, you might explore some healthy stress management techniques to keep involuntary reactions in check.
- By Body Odd
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Doctor's Visits:
Why Checkups Are Vital. . . . . .
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 Annual Physicals 101:
When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you've grown older, you may have gotten out of this habit.
Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor's visit will help you live a long and
healthy life.
It is also very important for you to play an active role to get the most out of your doctor's visit. Before your exam, review and update your family health history, be prepared to ask if you're due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.
During your actual doctor's visit, don't be shy about getting your questions answered. Also, if the doctor gives you advice about specific health issues, don't hesitate to take notes. Time is often limited during these exams, but by coming prepared you're sure to get the most out of your checkup.
Have you scheduled your physical for 2018 yet?
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Spring Recipe:
Penne with Chicken and Asparagus
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 "A light but super-tasty pasta dish, with fresh asparagus cooked in broth with sauteed garlic and seasoned chicken."
Ingredients
- 1 (16 ounce) package dried penne pasta
- 5 tablespoons olive oil, divided
- 2 skinless, boneless chicken breast halves - cut into cubes
- salt and pepper to taste
- garlic powder to taste
- 1/2 cup low-sodium chicken broth
- 1 bunch slender asparagus spears, trimmed, cut on diagonal into 1-inch pieces
- 1 clove garlic, thinly sliced
- 1/4 cup Parmesan cheese
Directions
- Bring a large pot of lightly salted water to boil. Add pasta, and cook until al dente, about 8 to 10 minutes. Drain, and set aside.
- Warm 3 tablespoons olive oil in a large skillet over medium-high heat. Stir in chicken, and season with salt, pepper, and garlic powder. Cook until chicken is cooked through and browned, about 5 minutes. Remove chicken to paper towels.
- Pour chicken broth into the skillet. Then stir in asparagus, garlic, and a pinch more garlic powder, salt, and pepper. Cover, and steam until the asparagus is just tender, about 5 to 10 minutes. Return chicken to the skillet, and warm through.
- Stir chicken mixture into pasta, and mix well. Let sit about 5 minutes. Drizzle with 2 tablespoons olive oil, stir again, then sprinkle with Parmesan cheese.
Nutrition Facts
Per Serving:
332 calories;
10.9 g fat;
43.3 g carbohydrates;
16.7 g protein;
20 mg cholesterol;
69 mg sodium.
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Recipe by:
LAUREL B, All Recipes
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When Are You Most Likely to Be in a Bad Mood?
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 Sometimes bad moods are triggered by an obvious source, such as a fight with a loved one or bad traffic on the way to work. Other times, however, you may feel like you are less in control of your mood, and you feel grouchy without much of a clear cause. In fact, these slumps may be a regular part of your day, arising in a predictable pattern. That's because your mood correlates to your circadian rhythm, which is the 24-hour cycle that regulates when you feel sleepy and when you wake up in the morning. Knowing when you are most likely to be pushed into a bad mood during the day can help you schedule important meetings and events accordingly, so that you maximize on the positive energy that occurs between these slumps.
First thing in the morning
Waking up is not always easy, especially for those who don't identify as "morning people." First thing in the morning, you will experience a sensation called
sleep inertia, which results from the slow process of waking up. Your body needs time to awaken, and the process isn't instant. For some people, it's easy to get past the initial grogginess of waking up by focusing on the excitement of a new day. Others may need some liquid ambition in the form of a cup of coffee to kickstart the body and reduce grogginess and negative feelings. If you want a more natural solution for promoting a positive early morning mood, try taking these steps.
- Go to bed earlier and wake up earlier to reduce the stress of getting ready in the morning.
- Allow yourself time to lie in bed with the curtains open, letting sunlight into your room.
- Schedule morning appointments to reduce the urge to go back to bed.
- Eat a healthy, filling breakfast.
Late in the afternoon
Once you've gotten past your early morning sluggishness, you might feel energized and ready to take on the day by about 10 a.m. You may feel more focused and awake, right up until lunch. You eat your lunch and get back to the office, and then you feel a crash in your energy levels that immediately affects your mood. This post-lunch lull is a common feeling that correlates with a change in how the brain perceives
risk and reward. In the middle of the day, there is the lowest perceived reaction of reward processing, which basically means that everything feels a little less good in the
late afternoon. That might mean that you feel crankier and more eager to get out of the office. If possible, try to avoid important meetings during this time, and reserve some of your more mindless, administrative tasks for this point in the afternoon.
Though it can be more difficult to control your mood during these times of day, you can still take steps to stay positive and productive.
- By Body Odd
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Book Reviews By Pat. . . . . .
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Pat |
"Not Your Usual Book Review"
No "heart beating suspense"! No chuckles, broad smiles, or down home humor. None of the "normal" anticipations we have of a "good read"!
However, you are encouraged to anticipate all kinds of emotions should you choose to read either or both of the selections for this issue's review.
BOTH books are recommended. BOTH are guaranteed to challenge the reader, inform and perhaps (hopefully!) BOTH will provide satisfaction and information neither of which comes with criticism (except "self criticism" but no need for THAT!). Read and apply at your own pace, You are encouraged to do so with a positive attitude in the "try it you'll like it" category.
The first book is the "
Mac Book Pro" by Guy Hart-Davis (the fast & easy way to learn, 2nd edition). The second book is "
The Second IPhone Book" by Scott Kelby and Terry White. Both books are not only "readable" but are practically applicable i.e. "helpful and easily understood"!!! Still not sure??? Try "easy-peasy"!
Technically savvy sales personnel have been encouraged to share these books with those of us who need/appreciate the availabililty of immediate assistance when technically challenged They have! (followed with thanks and appreciation).
Not your "cup of tea"???? Try it! You'll like it!
Just a suggestion to help you through the murk and mire of the technical challenges we face everyday. Enjoy! With these titles by our side ....
".YES! WE CAN..!
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Insights By Steve: Check it Out!
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Think About It!
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Insight By Steve (Author)
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"Learn from yesterday. Live for today. Hope for tomorrow." - Albert Einstein
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We Need Your Help!
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 Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
Tips:
1. If you need a refill, be sure to call your pharmacy FIRST, not our office. They will know if you have more refills, and if not, they will call/fax/electronically message us with your request. Then we will contact you if there is a question or concern.
2. Remember to call your pharmacy in plenty of time so you do not run out of your medications. Sometimes we need up to 48 hours to complete a request and we do not want this to be a hardship for you.
3. Register and use our SECURE PATIENT PORTAL for refill requests. We monitor this continually and again will contact you if there is a problem.
4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office. We cannot mail or any medications outside our office. Please plan ahead and make arrangements!
We are always here to help you and appreciate the opportunity to care for your healthcare needs!
Yours in good health,
Dr. Lakin & Staff
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Have a safe and healthy Spring!
Dr. Douglas Lakin & Staff
Paradise Valley Medical Clinic PC
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On our yearly trips to PA and VA visiting family we usually enjoy searching out interesting towns in nearby WV. A long time favorite of ours has been Greenbriar County and the upscale town of Lewisburg close to the Greenbriar resort in southeastern WV. There are bed and breakfasts for lodging as well as the classic General Lewis Inn where we have stayed. Antique and art stores abound as well as a Carnegie performing arts center and great restaurants. We felt quite at ease exploring the Greenbriar resort on our own one afternoon and enjoyed dessert there. 
However in the northern part of WV close to the MD and PA border we recently discovered two small towns that also have enough atmosphere for several days, Shepherdstown and Berkeley Springs. Berkeley Springs is a spa town dating back to the era of George Washington and his personal outdoor bath is marked in a historic park. Now you can take the cure inside a spa building located in the park. We have stayed several times in the large white Berkeley Springs Inn that dominates the town. On a hill above the Inn we climbed to a very old stone prison. 
